Extramammary Paget's disease (EMPD) is a rare malignant skin disease that is often confused with chronic eczema.[1][2] The study analyzed 40 patients with EMPD and 40 patients with chronic eczema diagnosed by histopathological examination between January 2020 and December 2024.[1] Clinically, the two diseases differed: patients with chronic eczema had more frequent itching and more severe scaling, while patients with EMPD showed a higher incidence of nodules, pigmentation, and hypopigmentation.[1] Dermoscopically, EMPD was predominantly milky red in color with evenly spaced punctate and spherical vessels, in contrast to chronic eczema characterized by clustered punctate vessels.[1] EMPD was further distinguished by a higher frequency of gray or brown dots, gray or brown amorphous areas, bright white lines, and reticular structures.[1] The results suggest that dermoscopy plays an important role in the early and accurate diagnosis of EMPD and its differentiation from chronic eczema.